These are what I call "Daily Quizzes" because I intend to post them after each lecture. To reveal the answers, highlight the area after the question (click and drag). If you print these out, the answers will appear as well. I strongly recommend that you attempt to answer the question before revealing the answer to check your study habits and to involve (challenge) yourself in the learning process.

Here are some case studies to think about. I have tried to include pertinent details that were mentioned in class, but not all the possible signs and symptoms.

Case #  1  A high powered corporate executive, 45 years of age, comes to see his doctor. He leads a fast-paced life and eats whatever and whenever he can. He has been experiencing some stomach upset and pain for some time, but has been taking antacids and aspirin for the condition. He feels fatigued, and has noticed his tongue is red and sore. You notice his fingernails are brittle and concave. Now you are pretty sure you know that his problem is: iron deficiency anemia, probably due in part to a bleeding ulcer!
A blood smear would show: small, pale erythrocytes

Case # 2 A 35 year old woman comes into the doctor complaining of fatigue, difficulty breathing and rapid heart rate. This person was grossly overweight but has had a section of their stomach removed and is losing weight. They should be feeling better, not worse!  They have also been experiencing some numbness and tingling in their arms. You realize the problem could be: B₁₂ deficiency anemia (pernicious anemia)
A blood smear would show: unusually large red cells with a normal amount of hemoglobin
If untreated, this woman will probably: die of heart failure

Case # 3 An 8 year old black female is brought into the emergency room. She is in pain, and having difficulty breathing. She had spent the afternoon strenuously playing outside with her cousins before the attack occurred.What condition might you consider in this case? Sickle cell anemia (sickle cell crisis)
If you were right, what would a blood smear show? crescent shaped red blood cells
What is causing the pain? Ischemia due to sickled cells obstructing blood flow. This can lead to life-threatening organ damage.

Case  #4   A 52 year old homeless man is brought into the hospital where you are working. He has been living on cheap wine and what little food he could find. He is experiencing fatigue, tachycardia, and you observe that there are scales and fissures around his mouth, which is inflamed, and he has ulcerations of his buccal mucosa and tongue. Having just studied your pathophysiology, you recognize his condition as:
Folic acid deficiency anemia.
A blood smear would show: unusually large red cells with a normal amount of hemoglobin
What other individuals are at risk for developing this condition? Pregnant and lactating women.

Case # 5 A  25 year old male comes to see his doctor because he is experiencing fatigue, difficulty breathing and a rapid heart rate. In doing a preliminary examination, you notice that his liver and spleen are enlarged, and there is a bronze tinge to his skin. You suspect: Sideroblastic anemia
Interestingly, this patient may require both: blood removal (phlebotomy) and transfusions.
A bone marrow smear would show: red cells containing iron granules arranged in a circle around the nucleus.

Case # 6 A 70 year old male presents to his doctor headache, dizziness, and diffuse itching. A physical exam reveals increased blood pressure and an enlarged spleen. A history shows that he came to this country from Denmark many years ago, and is of Jewish heritage. You suspect his red blood cell count will be: abnormally high. You suspect: Polycythemia vera

Case # 7A woman  recently arrived from Greece brings her 3 month old child to the emergency room with all the signs and symptoms of anemia. His blood smear shows a decreased number of red cells, and these are small, pale, abnormally shaped erythrocytes. Given the age and heritage of the child, you would be lead to suspect: thalassemia.

Which is never a normal state, leukopenia or leukocytosis? What would you expect if it happened? Leukopenia - a decrease in the number of white blood cells. This would manifest itself as a decreased resistance to infections.
What neoplasm associated with leukocytes acts as a solid mass?  Lymphoma.
In a person with an acute myeloid leukemia what would a blood count show ? Increased numbers of granulocytic white blood cells : neutrophils (mostly) and eosinophils and basophils.
Chronic lymphocytic leukemia usually is due to an increase in : B cells, only rarely are T cells involved.
In chronic lymphoid leukemia, the most common, leukemia, fatigue and weight loss are often (mistakenly) thought to be due to: the aging process.
What disease causing microorganisms are associated with:
    Hodgkin's Lymphoma : the Epstein-Barr virus.
    Non-Hodgkin's Lymphoma : Helicobacter Pylori
A patient presents with a very enlarged spleen. You may expect to see decreased numbers of what in a blood count?  platelets (thrombocytes)
A dietary deficiency of vitamin K would show up as: decreased blood clotting ability due to a decrease in the production of clotting factors by the liver.
Case # 8 A 25 year old male presents with a painless lump in his neck. He has been experiencing fatigue, weight loss, intermittent fever and night sweats. A biopsy of the lump reveals  large, multinucleate cells in which the nuclei are surrounded by clear nucleoplasm. The diagnosis can now be made of:
Hodgkin's lymphoma.
I do not expect to be able to quiz you on everything you need to know for the exam, but I will try to prod you along in the right direction.
Why does a person who locks their knees and stands at attention for a long time tend to faint? Blood tends to pool in the easily dilated veins of the legs. Two mechanisms help blood return to the heart: the one way flow assisted by valves in the veins and the "milking" action of muscle contractions in the legs( contraction of the skeletal  muscles squeeze the blood out of one section of  vein into the next). If the legs are locked so that there is no muscle contractions, the person's blood pools and the person faints due to decreased blood pressure and blood flow to the brain.
What vessels:
participate in nutrient and waste exchange - capillaries
act as a blood reservoirs - veins
act as pressure reservoirs - arteries, especially large, elastic arteries such as the aorta

When a body adapts to conditions of anemia:
    blood vessels - dilate
    the respiratory system - increases rate and depth of breathing
    the heart - increases rate of contraction

Ken Tait is a 34-year old teacher who presents in the emergency room with extreme fatigue and shortness of breath. His skin and sclera appear to have a yellowish discoloration. These findings are consistent with which type of anemia? This should not be difficult if you remember that hemoglobin is broken down into bilirubin, a yellow-orange pigment that is usually excreted in the bile and when the bile ducts are blocked or the liver is damaged, the bilirubin gives the skin a yellow coloration, called jaundice. Here we have a case of Hemolytic anemia  where the red blood cells are being broken down faster that the liver can clear the bilirubin from the blood.
In chronic hypertension, what adaptive changes would you expect to see occurring in the arteries? The tunica media would undergo hypertrophy to counter the addition stress placed on the vessels.
The chamber of the heart that generates the highest pressure is the: left ventricle
What part of the nervous system sends impulses to the heart via the vagus nerve and which slow heart rate and force of contraction? Parasympathetic nervous system.
The pressure generated at the end of diastole is called: Preload
Multiplying heart rate by stroke volume gives you: cardiac output.
Why does arteriosclerosis raise systolic blood pressure? The arteries are thicker and less distensible (stretchy), so we have a large volume of blood going through a relatively narrow tube.
When does angina pectoris occur? When the oxygen supply to the heart muscle has fallen below the demand of the tissue.
True or false: angina pectoris always indicates coronary artery disease. False. In Prinzmetal angia the problem is vasospasm and can occur when the patient is at rest or even sleeping.
When is angina pectoris a sign of impending heart attack? When the pain lasts for more than 20 minutes and does not ease with rest, or is a worsening of a pre-existing condition.
True or False: Most people with myocardial ischemia will feel a pain behind the sternum that may radiate into the jaw and left arm. False. Only 20 -30 % (less than one-third) of patients experience this pain.
We divided pericarditis into three types. What are they? Acute, pericardial effusion, and constrictive.
Which form of pericarditis would give muffled heart sounds? A friction rub? Pericardial effusion. Acute pericarditis.
True or False: Pericardial effusion is a problem only if it develops slowly over time. False. Like many conditions of the body, slowly developing pericardial effusion allows the body to adapt - the pericardium  stretches over time. In this case the pericardium can hold up to 2 liters of fluid!
What other characteristic sign would be present with pericardial effusion? Pulsus paradoxus
A patient presents with bulging jugular veins, enlarged liver and spleen, weight loss and edema. A large white area is seen in the center of his chest on x-ray. Blood pressures on inspiration and expiration are normal. What might you diagnose? Chronic constrictive pericarditis - the pericardium can become calcified (which will show up on x-ray and other imaging systems) and does not allow the heart to properly fill with blood, causing the blood to back up into the venous circulation, leading to increased venous pressures and edema.
What would you prescribe for this patient? diuretics and a restricted salt diet to decrease blood volume and load on the heart, digitalis to increase strength of cardiac contractions, and perhaps surgical removal of the pericardium if the condition was severe enough.
What are the three functional categories of cardiomyopathies? Dilated, hypertrophic and restrictive. Remember, that all three start out as the heart's means of compensating for a problem. Review why each occurs.
The valves most commonly involved in valvular dysfunction are: the bicuspid or mitral and aortic valves. Notice that these are both on the left side of the heart.
What would cause dysfunction of only the tricuspid valve? This has been associated with individuals who inject illegal drugs or use performance enhancing drugs.
What two types of valvular dysfunction are seen? Stenosis, or hardening and narrowing of the valve opening , and regurgitation, a failure of the cusps of the valve to close properly and prevent backflow of blood.
Which vavlular disorder would cause:
    a hypertrophy of the left atrium and a rumbling decrescendo diastolic murmur? mitral stenosis
    a widened pulse pressure and throbbing peripheral pulses? aortic regurgitation
    a narrowed pulse pressure and crescendo-decrescendo heart murmur? aortic stenosis
    a loud pansystolic murmur that radiates to the back and axilla? mitral regurgitation
    anxiety, depression, panic attacks, atypical chest pain, and a midsystolic click? mitral valve prolapse
What bacterial disease is a common cause for four of these disorders? Rheumatic heart disease- usually caused by a streptococcal infection.
Which one may be an autosomal dominant inherited trait? Mitral valve prolapse
The leading cause of ischemic heart disease is: coronary artery disease.
There are many risk factors for developing coronary artery disease. Which ones are modifiable (do you have control over?) cigarette smoking, obesity (at least to some extent), sedentary life-style, heavy alcohol consumption, also to some extent : hypertension and hyperlipidemia.
Which risk factors are non-modifiable? diabetes mellitus and genetic predisposition
Jerry Jones, 45, experiences chest pain every time he tries to go jogging. However, if he rests, the pain never lasts more than five minutes before it goes away? What is wrong with Jerry? Stable angina pectoris caused by a narrowing and hardening of the coronary vessels so that they cannot dilate in response to increased oxygen demands of the body.
Some of the drugs used in the treatment of angina are nitrates, Beta blockers, and calcium channel blockers. Why are they used and how do they work? Nitrates dilate peripheral blood vessels, which decreases blood pressure, also relieves spasms of the coronary vessels, increasing blood flow to the heart. beta blockers block sympathetic nervous system input to the heart, slowing rate and force of contraction, therefore decreasing the oxygen demands of the heart. calcium channel blockers prevent the inflow of calcium into the myocardium, also decreasing force of contraction of the heart.
Besides the fact that it can kill you, why is a myocardial infarction (heart attack) a bad thing? An infarction involves the death of tissue. This area of the heart will be repaired with scar tissue which does not contract, and will resist stretching for filling the heart.
Why is the production of renin during heart failure a bad thing? Renin is produced by the kidneys when they are not receiving adequate blood flow (in this case because the heart is not pumping properly.) Renin activates the formation of angiotensin II which constricts peripheral vessels, raising blood pressure and also afterload making it harder for the heart to pump blood against this vascular resistance. It also triggers the release of aldosterone and ADH which cause the body to retain sodium and water. These increase blood volume and blood pressure. Now the heart also had an increased preload in the fact it has more blood to cope with. Since it can't adequately pump the blood, it will back up into the lungs, causing vascular congestion and edema, and will then increase the afterload to the right side of the heart, which compensates poorly and eventually also fails. Remember , the most common cause of right heart failure is left heart failure.
Right heart failure that occurs without left heart failure is usually due to:  lung problems, such as chronic obstructive pulmonary disorders, cystic fibrosis, and adult respiratory distress syndrome.